Assessment of nursing students and nurses' orientation towards patient-centeredness

Background - Being patient centered is a core value for nursing. Patient centered-care has been related to patient and health provider satisfaction, better health outcomes, higher quality of care and more efficient health care delivery. Objectives - The purpose was to assess the orientation adopted by nurses and students in patient care, using The Patient-Practitioner Orientation Scale, as well as to compare the results between resident nurses and students from different academic years. Settings - Public School of Nursing and a Central Hospital, in Lisbon (Portugal). Participants - Students in the first, second and fourth year of nursing school and nurses participated in the study. Methods - For data collection, we used The Patient-Practitioner Orientation Scale (European Portuguese version), an instrument designed to measure individual preferences toward the dimension of caring a sharing in health professional-patient relationship. Students and nurses also filled out two additional questions about their perception of competence in technical and communication skills. Additional demographic information was also collected, including gender, age, academic year and length of professional experience. Results - A total of 525 students (84.7% female) and 108 nurses (77.8% female) participated in this study. In general, caring sub-scores, measuring the preference of about attending to patient emotional aspects, were higher than sharing sub-scores, measuring beliefs about giving information and perceiving patient as a member of the health team. Students were significantly more patient-centered throughout their nursing education (p<0.001). Comparing to students in the second and fourth academic years (p<0.001) nurses' scores were significantly lower both in total PPOS and in caring and sharing subscales. Conclusions - These results reinforce the idea that patient centeredness may be developed in academic context. The scores obtained highlight the importance of studies that aim to identify factors that may explain the decrease of patient centeredness in professional practice.

Radiological imaging in digital systems: the effect of exposure parameters in diagnostic quality and patient dose

Esta tese pretende contribuir para o estudo e análise dos factores relacionados com as técnicas de aquisição de imagens radiológicas digitais, a qualidade diagnóstica e a gestão da dose de radiação em sistema de radiologia digital. A metodologia encontra-se organizada em duas componentes. A componente observacional, baseada num desenho do estudo de natureza retrospectiva e transversal. Os dados recolhidos a partir de sistemas CR e DR permitiram a avaliação dos parâmetros técnicos de exposição utilizados em radiologia digital, a avaliação da dose absorvida e o índice de exposição no detector. No contexto desta classificação metodológica (retrospectiva e transversal), também foi possível desenvolver estudos da qualidade diagnóstica em sistemas digitais: estudos de observadores a partir de imagens arquivadas no sistema PACS. A componente experimental da tese baseou-se na realização de experiências em fantomas para avaliar a relação entre dose e qualidade de imagem. As experiências efectuadas permitiram caracterizar as propriedades físicas dos sistemas de radiologia digital, através da manipulação das variáveis relacionadas com os parâmetros de exposição e a avaliação da influência destas na dose e na qualidade da imagem. Utilizando um fantoma contraste de detalhe, fantomas antropomórficos e um fantoma de osso animal, foi possível objectivar medidas de quantificação da qualidade diagnóstica e medidas de detectabilidade de objectos. Da investigação efectuada, foi possível salientar algumas conclusões. As medidas quantitativas referentes à performance dos detectores são a base do processo de optimização, permitindo a medição e a determinação dos parâmetros físicos dos sistemas de radiologia digital. Os parâmetros de exposição utilizados na prática clínica mostram que a prática não está em conformidade com o referencial Europeu. Verifica-se a necessidade de avaliar, melhorar e implementar um padrão de referência para o processo de optimização, através de novos referenciais de boa prática ajustados aos sistemas digitais. Os parâmetros de exposição influenciam a dose no paciente, mas a percepção da qualidade de imagem digital não parece afectada com a variação da exposição. Os estudos que se realizaram envolvendo tanto imagens de fantomas como imagens de pacientes mostram que a sobreexposição é um risco potencial em radiologia digital. A avaliação da qualidade diagnóstica das imagens mostrou que com a variação da exposição não se observou degradação substancial da qualidade das imagens quando a redução de dose é efectuada. Propõe-se o estudo e a implementação de novos níveis de referência de diagnóstico ajustados aos sistemas de radiologia digital. Como contributo da tese, é proposto um modelo (STDI) para a optimização de sistemas de radiologia digital.

How important is personality in neurological patient' quality of life perception?

In the last decades, the value of research on neurological patients’ quality of life (QOL) has become unquestionable. In this context, most studies focus on the relationship between patients’ QOL and their sociodemographic and/or clinical and/or modifiable psychosocial characteristics. They give us information regarding the sociodemographic and clinical profile most prone to low QOL reports and also on ways to improve patients’ QOL (e.g., targeting their selfesteem). Nevertheless, little is known about the role nonmodifiable psychosocial variables can have on patients’ QOL perception. Consequently, the aim of the present study is to explore the relationship between QOL and personality in neurological patients.

Assessment of patient dose in digital systems

The assessment of patient dose has gained increased attention, still being an issue of concern that arises from the use of digital systems. The development of digital technology offers the possibility for a reduction of radiation dose around 50% without loss in image quality when compared to a conventional screen–film system. Digital systems give an equivalent or superior diagnostic performance and also several other advantages, but the risk of overexposure with no adverse effect on image quality could be present. This chapter refers to the management of patient dose and provides an explanation of dose-related concepts. In this chapter, exposure influence in dose and image representation and the effects of radiation exposure are also discussed.

Natureza, princípios e fundamentos das práticas e relações profissionais-doentes no contexto do Gabinete de Sub-visão do Instituto Dr. Gama Pinto

A institucionalização do direito à saúde, na constituição de 1976, como direito social e humano não parece ter conseguido, na prática dos profissionais de saúde, abalar a relação paternalista que coloca o doente numa situação de submissão face à dominância do poder/saber médico central ou periférico que o doente, nos termos de Parsons, deve acatar humildemente como “um bom doente”. É este papel de passividade e submissão do doente que nos propomos problematizar nos meandros dos direitos humanos/direitos sociais de cidadania como campo de construção social assente em práticas norteadas por direitos e deveres que, nos termos de Foucault, submetem os cidadãos a constrangimentos inerentes às relações de poder.

Public relations in part-time : full-time service: estratégia de comunicação para o lançamento de um novo modelo de negócio ds relações públicas em Portugal

O presente trabalho visa propor uma estratégia para a construção e lançamento de um novo modelo de negócio para a atuação das Relações Públicas em Portugal, numa proposta direcionada para as micro e pequenas empresas. Entre o serviço in house e a consultadoria clássica existe um espaço não coberto em Portugal: um serviço in house partilhado. Apresenta-se aqui este projeto de serviço de Relações Públicas para aqueles para quem é incomportável assumir nos seus quadros um Técnico de Comunicação.

As relações públicas para além das guest relations: relatório de estágio no grupo Porto Bay Hotels & Resorts

Foi realizado um estágio no grupo Porto Bay Hotels & Resorts, um grupo hoteleiro da Região Autónoma da Madeira, com a duração de três meses. Apresenta-se assim no presente trabalho uma perspectiva das Relações Públicas no sector do turismo e hotelaria bem como a discussão do porquê do afunilamento desta função de gestão das relações entre as organizações e os seus públicos nas Guest Relations em algumas das unidades hoteleiras em que trabalhámos. O turismo é actualmente um dos principais sectores da economia mundial. A sobrevivência de um destino turístico, unidade hoteleira ou mesmo de um resort, depende em muito da percepção que os seus stakeholders têm da qualidade dos seus serviços. Assim as Relações Públicas, como em outros sectores, assumem um papel de destaque sendo que estas têm a capacidade de trabalhar a relação entre uma organização e os seus stakeholders, gerindo conflitos e expressando uma identidade positiva sobre a mesma e trabalhando a sua reputação e visibilidade. Em suma este trabalho pretende compreender e reflectir sobre as relações públicas no sector do turismo e hotelaria mesmo quando não o são assim entendidas. Defender-se-á uma perspectiva global, integrada e proactiva das Relações Públicas no sector hoteleiro.

The hospital survey on patient safety culture in Portuguese hospitals: instrument validity and reliability

Purpose – Quantitative instruments to assess patient safety culture have been developed recently and a few review articles have been published. Measuring safety culture enables healthcare managers and staff to improve safety behaviours and outcomes for patients and staff. The study aims to determine the AHRQ Hospital Survey on Patient Safety Culture (HSPSC) Portuguese version's validity and reliability. Design/methodology/approach – A missing-value analysis and item analysis was performed to identify problematic items. Reliability analysis, inter-item correlations and inter-scale correlations were done to check internal consistency, composite scores. Inter-correlations were examined to assess construct validity. A confirmatory factor analysis was performed to investigate the observed data's fit to the dimensional structure proposed in the AHRQ HSPSC Portuguese version. To analyse differences between hospitals concerning composites scores, an ANOVA analysis and multiple comparisons were done. Findings – Eight of 12 dimensions had Cronbach's alphas higher than 0.7. The instrument as a whole achieved a high Cronbach's alpha (0.91). Inter-correlations showed that there is no dimension with redundant items, however dimension 10 increased its internal consistency when one item is removed. Originality/value – This study is the first to evaluate an American patient safety culture survey using Portuguese data. The survey has satisfactory reliability and construct validity.

Public relations, satisfaction and commitment

The importance of the organizational relationship (senior managers) with an internal public (employees) is the main focus of this research, aiming to understand how this relationship differs between the different publics. Nowadays, the relevance attributed by Public Relations to this relationship is crucial. The main purpose is to identify two consistent models to measure the impact of an organizational relationship on the internal public. The second purpose is to identify how the internal public react to this organizational relationship, namely by gender. The research was conducted in nine Portuguese companies with a sample of 1.244 subjects in order to study the context of the relationship and validate the identified models. The results show the gender stereotypes in the relationship in these companies and that the organizational relationship has an impact on organizational commitment with a consistent model that highlights the impact of Public Relations on a company's productivity.

Public relations, satisfaction and commitment

The importance of the relationship with an internal public is the main focus of our research. Nowadays, the relevance attributed by Public Relations to this relationship is crucial. Our purpose is to identify two consistent models to measure the impact of an organizational relationship on its internal public. The research was conducted in nine Portuguese companies with a sample of 1244 subjects in order to study the context of the relationship and validate the identified models. The results show us the gender stereotypes in the relationship in these companies and that it is possible to identify the impact of Public Relations on a company's productivity.

Reproducibility of simulated myocardial lesions simulated on a virtual phantom

Human virtual phantoms are being widely used to simulate and characterize the behavior of different organs, either in diagnosis stages but also to enable foreseeing the therapeutic effects obtained on a certain patient. In the present work a typical patient’s heart was simulated using XCAT2©, considering the possibility of a lesion and/or anatomical alteration being affecting the myocardium. These simulated images, were then used to carry out a set of parametric studies using Matlab©. Although performed in controlled sceneries, these studies are very important to understand and characterize the performance of the methodologies used, as well as to determine to what extent the relations between the perturbation introduced at the myocardium and the resulting simulated images can be considered conclusive.

Intervenção para a segurança do doente: análise dos obstáculos existentes na transferência de informação durante a passagem de turno de enfermagem

Mestrado em Intervenção Sócio-Organizacional na Saúde - Ramo de especialização: Políticas de Administração e Gestão de Serviços de Saúde

A checklist for patient safety rounds at the care pathway level

Objective - To define a checklist that can be used to assess the performance of a department and evaluate the implementation of quality management (QM) activities across departments or pathways in acute care hospitals. Design - We developed and tested a checklist for the assessment of QM activities at department level in a cross-sectional study using on-site visits by trained external auditors. Setting and Participants - A sample of 292 hospital departments of 74 acute care hospitals across seven European countries. In every hospital, four departments for the conditions: acute myocardial infarction (AMI), stroke, hip fracture and deliveries participated. Main outcome measures - Four measures of QM activities were evaluated at care pathway level focusing on specialized expertise and responsibility (SER), evidence-based organization of pathways (EBOP), patient safety strategies and clinical review (CR). Results - Participating departments attained mean values on the various scales between 1.2 and 3.7. The theoretical range was 0-4. Three of the four QM measures are identical for the four conditions, whereas one scale (EBOP) has condition-specific items. Correlations showed that every factor was related, but also distinct, and added to the overall picture of QM at pathway level. Conclusion - The newly developed checklist can be used across various types of departments and pathways in acute care hospitals like AMI, deliveries, stroke and hip fracture. The anticipated users of the checklist are internal (e.g. peers within the hospital and hospital executive board) and external auditors (e.g. healthcare inspectorate, professional or patient organizations).

Para lá dos jornalistas: influencer relations, uma nova era de Media Relations

Dissertação apresentada à Escola Superior de Comunicação Social como parte dos requisitos para obtenção de grau de mestre em Gestão Estratégica das Relações Públicas.

The impact of Sinogram-Affirmed Iterative Reconstruction on patient dose and image quality compared to filtered back projection: a narrative review

Objective: Summarize all relevant findings in published literature regarding the potential dose reduction related to image quality using Sinogram-Affirmed Iterative Reconstruction (SAFIRE) compared to Filtered Back Projection (FBP). Background: Computed Tomography (CT) is one of the most used radiographic modalities in clinical practice providing high spatial and contrast resolution. However it also delivers a relatively high radiation dose to the patient. Reconstructing raw-data using Iterative Reconstruction (IR) algorithms has the potential to iteratively reduce image noise while maintaining or improving image quality of low dose standard FBP reconstructions. Nevertheless, long reconstruction times made IR unpractical for clinical use until recently. Siemens Medical developed a new IR algorithm called SAFIRE, which uses up to 5 different strength levels, and poses an alternative to the conventional IR with a significant reconstruction time reduction. Methods: MEDLINE, ScienceDirect and CINAHL databases were used for gathering literature. Eleven articles were included in this review (from 2012 to July 2014). Discussion: This narrative review summarizes the results of eleven articles (using studies on both patients and phantoms) and describes SAFIRE strengths for noise reduction in low dose acquisitions while providing acceptable image quality. Conclusion: Even though the results differ slightly, the literature gathered for this review suggests that the dose in current CT protocols can be reduced at least 50% while maintaining or improving image quality. There is however a lack of literature concerning paediatric population (with increased radiation sensitivity). Further studies should also assess the impact of SAFIRE on diagnostic accuracy.